MEDICARE: DR. SHAUN ALEXANDER MCCRAE D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NS0005X	Sports Physician Chiropractor	DC-04446	OH

General Provider Information

NPI Number	:	1447571443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHAUN ALEXANDER MCCRAE D.C.

Provider Business Mailing Address
First Line	:	745 LAKE TRL
Second Line	:
City	:	AURORA
State	:	OH
Zip	:	44202-8478
Country	:	US
Telephone Number	:	713-873-1166
Fax Number	:

Provider Business Practice Location Address
First Line	:	745 LAKE TRL
Second Line	:
City	:	AURORA
State	:	OH
Zip	:	44202-8478
Country	:	US
Telephone Number	:	713-873-1166
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2010
Last Update Date	:	01/29/2021

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